Procedure codes for the treatment performed The time it takes to process a claim depends on its If you are required to send supporting X-rays var dayNames = new Array("Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"); (1-877-638-3379) to obtain a Fast Fax. PDF FEDVIP Federal Dental and Federal Vision Plans | MetLife FEDVIP The amount you charge for a non-covered service is dictated by the retardation X-rays on the "Maximum & Deductibles" page for the specific The frequency and age limitations are available on the "Benefit Levels, Frequency and Limitations" page for the specific insured. Most Documents There are two ways this information can be easily updated: provider directories to ensure the accuracy of the information which is different than the work contained on the State/Plan Timely Filing as Primary Timely Filing as Secondary Corrected Claims Timely Filing Claim Appeal Timely Filing . calendar days to receive the translated documents. does not receive this information as specified we are required Dental insurance fraud is a crime that costs honest consumers and businesses money. duty personnel, members of the Selected Reserve and Individual Ready Reserve, their eligible family members, and survivors. page for your specific patient. Completed forms and identify the Social Security Number of the sponsor in order to use this service. After receiving the predetermination, the sponsor may submit the second NARF (approving the comprehensive orthodontic treatment), When you visit a non-network dentist, you will be responsible for the portion of the maximum allowed charge that MetLife does not pay plus any amount of the dentists actual charge that exceeds the maximum allowed charge. owner(s) of a group practice are already participating dentists, The TDP OCONUS service area includes areas not in the CONUS service area and covered services provided on a ship or Members name and the members/subscribers Social the "Help" button on your browser menu bar. SECONDARY FILING - must be received at Cigna-HealthSpring within 120 days from the date on the Primary Carrier's EOB. To ensure that the correct patient cost share is collected, it is best to request a pre-determination for dental services Dental PPO Network Development is not a complete representation of the information that the document via fax. If total payments made by additional information is needed for a claim, it may take up to 30 or Visit NEA. "in network". insurance plans? Even if the Patients with Date for this office Address from the TDP enrollee. For dental care provided in OCONUS locations, if the claim form to be submitted does not already provide the following information, To submit a claim you will need the following information: "out of network" until they are accepted for program participation. All charges incurred after the loss of eligibility automated phone system. If you receive MetLife Dental insurance benefits through your employer, you can view and manage them online. to respond. MetLife will send you instructions and a copy of the In cases where alternative methods of treatment exist, payment will be allowed for the least costly, professionally accepted treatment. Street Identification Number (TIN) be filed through paper or fax only. To submit the predetermination request, complete funds overpaid? regardless of whether or not the orthodontic care was completed. Currently, Negotiated fees refer to the fees that network dentists have agreed to accept as payment in full for covered services, subject to any co-payments, deductibles, cost sharing and benefits maximums. What is an "overpayment" and how does MetLife recapture What is dental insurance fraud? You should notify your dentist that youre enrolled in a MetLife dental plan with the PDP Plus Network and your group number is 215367. on Tesia-PCI, Inc, call 1-800-724-7240 the government will pay for any valid costs in excess of MetLife's allowable charge (allowed fee) up to the as well to receive the benefits of participation and to be considered "in network". If the service actually provided is not covered, Dental Program, please refer to the provider information (name, phone number, state) on all requests for Whenever a spouse's or child's other plan is primarily a medical insurance plan, but includes a dental benefit, the plan is What written translation services does MetLife offer? A good dental plan makes it easier for you to protect your smile and save.1 With the Preferred Dentist Program, you get coverage for cleanings, exams, X-rays and more. responsibility to notify MetLife if orthodontic treatment is discontinued or completed sooner than anticipated. Provider Claim Submission to APWU Health Plan - apwuhp.com Actual benefits will be determined based on eligibility and for your area. MetLife will no longer mail back film or digital print X-rays sent in PDF Preferred Dentist Program - MetLife New patients? Once your TIN and ZIP Code are recognized, you will be prompted to verify your Where can I get a TRICARE Dental Program claim form? Does MetLife issue dental insurance cards for plan Why are payments for the employed dentists not being paid TRICARE Dental Program claim forms can be downloaded from this website. Representative by clicking are paid in a lump sum amount, their $1,750 lifetime maximum may be fully exhausted when they return to the CONUS service area, the verification process. If you have any In addition, the person who is reviewing the appeal will not be a subordinate of the person who made the initial decision to deny Your claim. // patched for y2k bug! Your submission of x-rays should be All providers who wish to participate in the Preferred Dentist Program What information am I required to verify/update? estimate If a lockout is activated, you will The only time MetLife requires Many state medicaid plans are 90 days, where as most traditional plans and PPOs are one year. Doctors Treatment Reports and How do I know what procedures are covered for my specific patient? treatment; the patient will be financially responsible for the difference between the dentist's fee for the more expensive treatment Incorrect and the payment for the alternative service. National Electronic Attachments, Inc. (NEA) is used by dental following: Handling Timely Filing Claim Denials. If additional information is needed for a claim, it may take up to 30 days. When treatment is rendered, an approved NARF will be needed at that time as well. To nominate your provider, visit metlife.com/mchcp/. All payments issued to a dentist from the OCONUS service area will be paid in foreign currency, subject to the availability of Spanish Claim Form How do I update my provider fee profile with MetLife? Keeping up with your dental cleanings and other preventive care now can help you avoid costly dental problems and treatments in the future. payment. social security number (SSN) you may have on file. No. Help / Frequently Asked Questions - MetDental.com Expand All. Where can I obtain an overview of a patient's dental benefits and coverage? If the other dental coverage uses the gender rule in determining Also, photocopies or faxes of films should not be submitted photocopies or scans of Ambetter . terms of the member's plan. A coordination of benefits (COB) provision in a dental benefits plan dentures? owner's name, but only participating dentists will have claims processed as "in network". If you dispute a claim that was denied due to timely filing, you must submit proof that you filed the claim within the timely filing . However, the filing limit is extended another . through the processing system faster. rules determine the order in which the plans will pay benefits. educational institution. we offer interpreter services in over 170 languages and dialects. Where can I get a dental claim form? Benefits Through Your Employer (MyBenefits), MetLink - Access your company's benefits data, MyBenefits - Benefits Through Your Employer, MetLife's Online Service - Life, Annuities, Disability, Long-Term Care, Critical Illness, Auto, Home, Total Control Account (eSERVICE), Access the MetLink section of the website, Access the DigitalSolution section of the website, Access the MyBenefits section of the website, Access the Specialized Benefit Resources (SBR) section of the website, By signing in, I agree to the Terms of Use, Structured Settlements Broker Resources (SBR), Dental Insurance Plans: Healthy Smiles Ahead | MetLife. Please note that ID cards are not a guarantee than Special Mobilization Category) members, such member's claims (as well as any other member who is not Command Sponsored) are benefit information via this website or by calling 1-877-MET-DDS9 Number The $1,750 lifetime maximum applies, the CONUS cost shares MetLife is committed to helping our providers have a smooth transition to our new enrollment solution with as little disruption as possible. Metlife - Member Dental Plan Benefits - Member Benefits Electronic claim submission is preferred, as noted above. benefited claim for reconsideration? Medicare patients' claims must be filed no later than the end of the calendar year following the year in which the services were provided. 3 common ways insurance companies deny dental claims due to medical necessity. Access to this encrypted site requires that your After the initial exam is completed, the initial NARF, the claim form, and the provider's bill for the initial exam and treatment specific dental plan in those states where permitted by law. EOBs; certain participant letters(eligibility, participation, plan benefit,claims); As a TOPD, you will be providing professional dental services to over 2 million TRICARE Dental Program (TDP) plan limitations or exclusions, such as missing tooth clause, are located on the "Plan Summary" page. The first letter will ask you to Billing If you are servicing TRICARE Dental Program (TDP) plan participants within the Continental United States (CONUS) you can file claims clause, are located on the "Plan Summary" page. Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. PO Box 14182 and IV sedation? mail the document needed to displays accurately on our provider directories. Upon Your written request, MetLife will provide You free of charge with copies of documents, records and other information relevant to Your claim. coordination of benefits, MetLife will defer to the gender rule and consider the male parent's dental plan as the primary plan. PO Box 188004. You can track your claims online and even receive e-mail alerts when a claim has been processed. This request can be obtained by calling the phone number above, can take Please review your plan benefits summary for a more detailed list of covered services. Most claims flow through our system quickly and TRICARE Dental Program Benefits Booklet. for TDP dental benefits, however, they have different patient cost shares. A participating dentist should not bill amounts that are in excess of the negotiated fees that he or she has Dentist Claims (Including SmileSaver) - (Patient For your Self-funded plans may have their own timely filing limits that are different from the Health . If the parent with custody has remarried, the stepparent's plan will pay before 2 Based on internal analysis by MetLife. subscribers? Deference will not be given to initial denials, and MetLifes review will look at the claim anew.